At MATTHEW ROAD BAPTIST CHURCH you will discover a warm group of real people dedicated to following our Lord and Savior, Jesus Christ. We look forward to meeting you. Our Motto at Matthew Road is: "A place to call home" We want you to feel at home at our church. Be our guest and see what many of your neighbors are discovering, a meaningful place to attend church. You'll be glad you did! From the moment you walk up to the building you can expect…
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Sunday Mornings 9:45 AMSunday Evenings 5:00 PMWednesday Evenings 6:45 PM
We believe that what we do ministry-wise should flow purposefully out of what we value and love. With this in mind, we focus our energies on, reaching out to our community, teaching the love and truth of the Bible, and sending as many as we can out into the world with the good news of forgiveness and life through Jesus Christ. To accomplish this, we…
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Camp 317 Soccer Camp
T&T Boys Laser Tag (spring 2020)
Summer Musical Camp
Preteen Retreat *FOR 3rd-6th Grade ONLY
Please note that each of these events require separate registration forms. This is only the medical release & liability form and no longer functions as an event registration.
Parent Name*
Phone*( ) -
Email*
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Name*
Date of Birth* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Name
Date of Birth January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Check the box to digitally sign this form and type your name below.
I am the parent or legal guardian of the above named child(ren) and I am informed of the activities offered by Matthew Road Baptist Church (“church”) located in the City of Grand Prairie, County of Dallas, State of Texas. As the parent or legal guardian of my child, I hereby consent for my child to attend and participate in all activities provided by this (Church).
Signature of Parent*
Date * January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Check the box to digitally sign this PARENT/GUARDIAN CONSENT TO MEDICAL, DENTAL, or HOSPITAL CARE and type your name below.
I consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further agree to pay all charges for the dental, medical, or hospital care or treatment. As parent or legal guardian of my child, I am responsible for the health care decisions of my child and am authorized to consent to the services to be rendered. I represent that my consent to and agreement to pay for the dental, medical, or hospital care or treatment to be rendered to my child is legally sufficient and that no consent from any other person is required by law.
Date* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Check the box to digitally sign this RELEASE, WAIVER, and IDEMNITY AGREEMENT and type your name below.
IT IS MY INTENTION BY THIS AGREEMENT TO EXEMPT AND RELIEVE MATTHEW ROAD BAPTIST CHURCH AND ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH OF MY CHILD(REN) CAUSED BY ANY ACT OF NEGLIGENCE OR MATTHEW ROAD BAPTIST CHURCH AND ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES. For and in consideration of permitting my child(ren) to observe or use any facility or equipment of MATTHEW ROAD BAPTIST CHURCH, or engage in and/or received instruction in any activity or activity incidental thereto SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY at: MATTHEW ROAD BAPTIST CHURCH, in the City of Grand Prairie, County of Dallas and state of Texas, the undersigned parent and/or guardian of the above named child(ren) hereby voluntarily and absolutely releases, discharges, waives and relinquishes any and all loss or damages or actions or causes of action for personal injury, property damage or wrongful death occurring to the above named child(ren) as a result of the above named child(ren) observing or using facilities or equipment of MATTHEW ROAD BAPTIST CHURCH, or engaging in or receiving instructions in any activities SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY or in activities incidental thereto wherever or however the same may occur, and for whatever period said activities or instructions may continue. The undersigned parent or guardian of the above named child(ren) for him/herself, his/her heirs, executors, administrators or assigns agrees that in the event any claim for personal injury, property damage or wrongful death shall be prosecuted against MATTHEW ROAD BAPTIST CHURCH or its officers, agents, servants, or employees, the undersigned parent or guardian will indemnify and hold harmless MATTHEW ROAD BAPTIST CHURCH and its officers, agents, servants or employees from any and all claims or causes of action by the above-named child(ren) or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the undersigned parent or guardian of the above-named child(ren) present any claim against MATTHEW ROAD BAPTIST CHURCH and said persons for personal injuries, property damage, wrongful death or otherwise cause by any act of negligence by MATTHEW ROAD BAPTIST CHURCH and said persons. The undersigned parent or guardian represent that he/she has read this Release, has requested and has been provided with, or has requested and declined advisement on the potential dangers/risks of engaging in the observation, activities, or instruction offered, assumes all risks associated with such dangers and risks, and is fully aware of and understands the terms and the legal consequences of the signing of this Release. The undersigned parent or legal guardian intends his or her signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Check the box to digitally sign this AUTHORIZATION for MEDICAL TREATMENT and type your name below.
I, the undersigned, am the parent or legal guardian of the above-named child(ren). My child is attending and participating in the above-named activity(ies) at Matthew Road Baptist Church (hereinafter “church”), located at: in the City of Grand Prairie, county of Dallas and the State of Texas. I hereby authorize the (supervisor/manager/pastor/camp director) and his/her officers, agents, servants, or employees that are 18 years of age or older, who supervise the activities at this (church) into whose care my child has been entrusted, to consent to medical care or dental care, or both for my child. The authority granted by this authorization includes the authority to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further authorize the (supervisor/manager/pastor/camp director) and his/her officers, agents, servants or employees that are 18 years of age or older, who supervise the activities at this (church) to receive physical custody of my child, upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to the (supervisor/manager/pastor/camp director) and his/her officers, agents, servants or employees that are 18 years of age or older who supervise the activities at this (church). It is understood that this authorization is given in advance of any special diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the supervisor or his/her authorized designee, in the exercise of his/her best judgment, upon advice of such physician, dentist and surgeon may deem advisable.
Medical/Health Insurance Company Insurance Policy # (If applicable)
Please note that this form system does not auto generate a confirmation email of submission; however, it should re-direct you to confirmation page. You may email jennifermrbc@gmail.com to confirm if needed. Thank you!
